Risk factors for pancreatitis in older women: the Iowa Women's Health Study

Abstract

Purpose Pancreatitis – an inflammation of pancreas – is a severe and costly disease. While many risk factors for pancreatitis are known, many cases, especially in elderly, are of unknown etiology. Methods Risk factors for acute (AP) and chronic pancreatitis (CP) were assessed in a prospective cohort (n=36,436 women, aged ≥65 years). Exposures were self-reported at baseline. Pancreatitis was ascertained by linkage to Medicare claims (1986–2004) categorized by a physician as: “AP”, 1 AP episode (n=511); or “CP”, 2+ AP or 1+ CP episodes (n=149). Results Multivariable odds ratios (OR) and 95% CI for AP and CP were calculated using multinomial logistic regression. Alcohol use was not associated with AP or CP. Heavy smoking (40+ versus 0 pack-years) was associated with a 2-fold increased OR for CP. For BMI ≥30 versus <25 kg/m2, the ORs were 1.35 (1.07–1.70) for AP (p-trend=0.009) and 0.59 (0.37–0.94) for CP (p-trend=0.01). ORs for AP and CP were increased for HRT use, heart disease, and hypertension. There were positive significant associations between protein and total fat intake for CP and AP. Conclusions We identified factors associated with AP and CP that may be specific to older women.

Dietary Factors Reduce Risk of Acute Pancreatitis in a Large Multiethnic Cohort

“…Diet rich in saturated fat and cholesterol ( e.g., eggs and red meat) were associated with a higher risk of GS AP, while intakes of vitamin D, milk, and fruits were associated with a reduced risk. Our results are consistent with findings from the Iowa Women’s Health Study which show that intakes of total and saturated fat were associated with an increased risk of AP 10 . A previous systematic review suggests that in humans, a prolonged exposure to a high-fat diet may work synergistically with gallstones to trigger an AP attack indicating a possible role of diet as a cofactor in the causation of AP 11 .…”

“…Insoluble fiber may also have a protective effect by reducing the development of gallstones 18 , a major cause of AP. A previous analysis in the Iowa Women’s Health Study, however, did not show an association between crude fiber intake with either AP or CP 10 .…”

Is Prior Aspirin Use Associated with Reduced Severity in Patients with Acute Pancreatitis?

“…Hypertension [17], cardiovascular disease [17,18], and diabetes [19,20] have been independently associated with the incidence of AP. Indeed, a higher number of the comorbid disease has been shown to associate with poorer outcomes in AP, including the length of hospitalisation and mortality [21].…”

Smoking induced pancreatitis and pancreatic cancer

“…al revealed a very important observation related to the spectrum of mutations of Glycine 12 in the Kras protein in the 3 cancers. In pancreatic and colon tumors, 85% and 74% of the mutations are Val or Asp in pancreatic and colon cancers, respectively, whereas in lung cancer only 37% are Val or Asp against 49% Cys compared to 3% and 8% Cys in pancreatic and colon cancers, respectively (82). This data suggest a possible association between the spectrum of mutations and the effect of smoking.…”

“…The meta-analysis study performed by Porta et. al showed no-significant association between Kras mutations and smoking status in pancreatic and colorectal cancers whereas significant association was found in lung cancer (82). The sequencing of the pancreatic cancer genome found that the difference in the total number of mutations between smokers and non-smokers was not driven by mutations of the known driver genes in pancreatic cancer such as Kras, p53, p16/CDKN2A and SMAD4, but instead was predominantly observed in genes mutated at lower frequency (16).…”